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Psylocybin? Easily?

You have to put effort into making an experience with psylocybin meaningful and helpful. It could go wrong very easily, especially for those who are in a difficult situation or headspace. (Speaking from experience.)

As for SSRIs? Safe, effective, with a handful of annoying side effects. Straightforward to use, low potential for misuse, requires sustained use for any intended effects. A doctor who already has familiarity with a patient's mild or moderate symptoms of anxiety or depression may very well just prescribe one if asked and if not contraindicated. Not that you should randomly start popping Prozac, but it's unlikely to hurt you if you did.

Ask your doctor, try the things that doctors currently believe are most likely to work first. If for whatever reason you choose to go beyond the current medical consensus, please stay safe and keep your doctor up to date.

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Impotence and weight gain are not just "annoying" side effects. They seriously impact your life. Just putting that out there.

I'm not claiming they don't. Everyone experiences SSRIs differently and it's common to shop around until you find one whose side effects impact your life in a more tolerable way.

That's in contrast to psylocybin, which has substantially more serious potential acute side effects, ones that are more difficult to understand and treat should they occur.

I'm not saying psylocybin is unsafe or that SSRIs are always preferable. But if I'm asked to compare their safety? The choice is obvious, weight gain notwithstanding.

I'm not claiming they don't.

You were clearly implying they don’t when you downplayed all SSRI downsides as “a handful of annoying side effects”.

Weight gain kills. Suicidal ideation also kills many people when they start SSRIs. People have killed themselves because of permanent sexual dysfunction caused by SSRIs that never went away after stopping the drugs (and yes, this is a known possible adverse effect listed in the official prescribing information).

I don’t think the choice is as “obvious” as you’re making it out to be.

I wasn't aware of PSSD (I don't seem to be alone on that front).

Leaving this link for others to pick up for more information: https://annals-general-psychiatry.biomedcentral.com/articles...

I guarantee you the number of people who have died from SSRI misuse is higher than the number of people who have died from psilocybin misuse. I'm not referring to things a person may do in a given state, I'm talking about effects from the drugs themselves. I'm not aware of a single recorded person who has taken any dose of psilocybin, and died from "psilocybin overdose". While it may be uncommon, it is possible to overdose on SSRIs.

Sure, psylocybin won't kill you, but the threat of inescapable psychological distress is real. Maybe it's less likely if you aren't predisposed to psychosis, but you can't easily know for sure that you're not.

And yes, it's possible to misuse SSRIs, but taking an obviously oversize dose is still often a treatable situation. Combining them with depressants I think is a degree of misuse that is incomparable.

> but the threat of inescapable psychological distress is real.

Really?

That is true of any meaningful experience

The danger with psychedelic drugs is very low

They wear off

While fishing for that right dosage of SSRIs you have a person with new boughts of mania and suicidal tendencies where there's no clarity on how to stop the experiment due to the complexity of blood level accumulation.

If SSRIs started as illegal drugs, with i.e. people starting them dodging medical supervision, I think the system would be telling us they are insanely risky and well beyond many scheduled drugs.

bouts*?

> it is possible to overdose

I'm not sure that's a good metric though. Paracetamol is more dangerous than most highly regulated pharmaceuticals in that way.

So are you okay with people choosing their own dose of SSRIs?

A prescribing doctor will not magically know the precise amount of an SSRI a patient should be taking, or which one to take. For most patients, finding the right drug and dosage is a process. And just like with psilocybin, no one would want to take a random amount. Like with any drug, a person would want to be informed and have proper guidelines about dosage from the start.

> Psylocybin? Easily?

Err.. no?

This is from the Dutch National Institute for Public Health and the Environment: https://www.rivm.nl/bibliotheek/rapporten/340001001.pdf

Page 19 onward has the charts. What do do we find at the very low end in terms of chronic and acute toxicity? Shrooms (“paddos”) and LSD.

It always blows my mind how anti-drug people will do a handwavey gesture to the authority of institutes like the FDA, but never actually check up on what actual research says.

> As for SSRIs? Safe, effective, with a handful of annoying side effects.

Except the multitude of ways you can put yourself into a serotonin coma.

I agree with your assessment that (first) use of psychedelics should be under proper guidance. But what you refer to, “going bad”, can sometimes be a traumatic past experience that people have stuffed away and by surfacing and processing it they can move past it. It’s not always meant to be kumbaya and flowers.

Educate yourself, then talk.

I'm not saying psylocybin can't be used safely, nor have I made any claims about its relative toxicity or harm relative to other scheduled drugs. If you're arguing anything else, I don't think that report says what you think it says. As for my position, I live in SF, it's decriminalized here, I support that. So there's no need for your rude presumption that I find it generally unsafe.

I'm also unfamiliar with the dose of SSRIs that would send you into a coma, but I'm fairly certain it's shockingly large. Happy to be informed otherwise.

edit to reflect parent edit: yes, I'm aware that breakthrough experiences can be helpful. I'm also saying they should not be your first resort.

> I don't think that report says what you think it says.

The report also speaks to personal, social and populational damage.

> I'm also unfamiliar with the dose of SSRIs that would send you into a coma

Its not the SSRI itself, but rather anything that messes with your reuptake can put you into some deep problems. And of course the bog-standard grapefruit+medicine interaction.

> I'm also saying they should not be your first resort.

My point was that if we are talking drugs, yes, treatment with psilocybin should definitely be higher up the list than SSRIs. SSRIs would most likely be for life, daily. Psilocybin could be bi-annually or perhaps even as spot treatment only.

> So there's no need for your rude presumption that I find it generally unsafe.

Apologies for coming off too strong. I just feel that, reasonable as it is, the “let’s all just take a minute” attitude gives too much ammunition to conservative hoohas to stymie these alternate treatments for another few decades. Imagine if marijuana had been more accessible to people like this in the 80’s-10’s:

https://youtu.be/zNT8Zo_sfwo?si=-0xxkGE22zk9q_bC

https://youtu.be/FSdjvEnyRzk?si=urVWAeUZ4fTCdUiw

> > You have to put effort into making an experience with psylocybin meaningful and helpful. It could go wrong very easily, especially for those who are in a difficult situation or headspace. (Speaking from experience.)

> What do do we find at the very low end in terms of chronic and acute toxicity? Shrooms (“paddos”) and LSD.

Breaking your mind doesn't count as toxicity. You're not responding to the point you tried to refute.

> Breaking your mind doesn't count.....

Hyperbole

It’s rather difficult to “break your mind” on psychedelics.

Unless you either A) already have a predisposition to something like, say, schizophrenia, or B) take stupendous amounts, you’ll be fine. And vis a vis point B, in the older days there were people who did multiple LSD hero doses, without frying their brain.

toxicity is the least of _psychoactive_ drugs problems

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